Just like fire scenes, technical rescue incidents involve strenuous activity, adverse environmental conditions, and require wearing sometimes cumbersome PPE. Even more so, these incidents often involve psychologically harrowing stress levels and inclement exterior conditions (rain, wind, extreme cold or heat) which can further complicate the situation.
We are all aware that heart attacks are the leading cause of fire service fatalities. Stress is a huge factor in precipitating a cardiac event. Studies abound that say that no extraordinary physical activity should simply be terminated; "cooling down" afterwards is important to allow the body to "de-stress" and return to normal. Personnel should have the opportunity to replenish lost body fluids, add nourishment, give the body a chance to heal, and to be monitored for any adverse effects of exposure.
Managing the resources actually involved in the rescue are given a lot of attention and are the focus of our efforts, but rehabilitation of the personnel involved in these incidents seem often like an afterthought. Planning for the provision of personnel rehabilitation ahead of time will allow more efficient and effective rehabilitation of personnel operating at the rescue scene.
Personnel assigned duties and functions at technical rescue incidents and training should be afforded emergency operations rehabilitation procedures as specified in NFPA 1500, Standard on Fire Department Occupational Safety and Health Programs :
- The fire department shall develop standard operating procedures that outline a systematic approach for rehabilitation.
- The incident commander shall consider the circumstances of each incident and initiate rest and rehabilitation in accordance with the standard operating procedures and with NFPA 1561, Standard on Emergency Services Incident Management System.
- On-scene rehabilitation shall include at least basic life support care.
- Each member operating at an incident shall be responsible to communicate rehabilitation and rest needs to their supervisor.
- A process shall be established for the rapid replenishment of water supplies.
Pre-planned rehabilitation programs are essential for the health and safety of members. The rehabilitation plan should be flexible enough to be implemented for small incidents as well as large-scale ones. Medical evaluation and treatment, food and fluid replenishment, team rotation, and shelter from extreme environmental conditions should be part of the plan.
Particularly in technical rescue, weather can impact the safety and health of members. Where these factors involve prolonged scene times or heavy exertion, personnel risk increases. Part of the rehabilitation procedure should provide for this contingency. Shelter can range from existing buildings or structures, to commercially produced tents or specialized vehicles. If resources are available regionally, find out what they are capable of and establish memoranda of understanding so that you can use them when the time comes. Apparatus can be used, but sometimes space in those vehicles, even in ambulances, is limited.
The assignment of an ambulance crew dedicated to REHAB is essential during long-duration or heavy-exertion incident operations. This crew can be designated to perform rehabilitation functions, as well as be available to provide medical care for personnel. This assignment should be independent of medical treatment and transport for victims. Medical evaluation and treatment in the rehabilitation area should be conducted according to EMS protocols developed by the fire department in consultation with the fire department physician and the EMS medical director. Especially since there is the likelihood of needing ALS for certain exposures (to provide intravenous therapy and cardiac monitoring), paramedical care is preferred to BLS.